Tracking progress and spending on nutrition

ID-100328810The Global Nutrition Report 2015: Actions and accountability to advance nutrition and sustainable development, has as a key theme the notion of tracking progress on tackling undernutrition as an important factor in holding donors, governments and other institutions to account. The data in the report itself plays a role in monitoring progress. At present, data allowing the monitoring of impact and reach of nutrition-specific interventions is limited. Lack of consensus on data, metrics and methods make monitoring difficult to undertake, analyse and compare, although improvements are being seen in actions to track nutrition.

Approaches to tackling undernutrition need to be multi-sectoral, which makes tracking both nutrition spending and progress towards targets difficult. As the Global Nutrition Report 2015 states, countries make progress when actions from multiple levels converge and reinforce each other in a virtuous circle. Nutrition-sensitive approaches, which seek to both reach a direct nutrition goal as well as address the factors underlying undernutrition, further complicate accurate measurement and monitoring.

Ickes et al (2015) calculated, based on data from the Organization for Economic Co-Operation and Development, estimates of nutrition aid received by countries with a high burden of undernutrition as well as investigated the relationship between this funding and nutrition measurements such as national stunting prevalence, stunting burden, and under-five mortality. In 2010, some US$379.4 million was given to nutrition specific projects and programmes and US$1.79 billion was committed to nutrition sensitive spending. The 25 highest burden countries accounted for 85% and 82% of this funding, respectively. The main areas of nutrition-sensitive spending were Reproductive Health Care (30.4%), Food Aid/Food Security Programs (14.1%), Emergency Food Aid (13.2%), and Basic Health Care (5.0%). The amount of nutrition sensitive and total nutrition Official Development Assistance was significantly correlated with stunting prevalence while the total number of stunted children in a country’s population was correlated with the amount of nutrition specific ODA. These results indicate not only the importance of nutrition-related funding in reducing stunting but also the importance of reliable estimates for nutrition spending for planning.

International funding for nutrition has, over the last five years, significantly increased. This rise has stimulated demand for greater accountability in the distribution of resources. As said, tracking nutrition expenditures is made difficult because nutrition spans several Ministries and involves multiple stakeholders. An Oxford Policy Management working paper by Picanyol et al (2015) entitled, Tracking Investments in Nutrition in Africa, reviews the experience of four countries (Tanzania, Madagascar, Ethiopia and Malawi) in tracking nutrition spending using different methods. Authors outline multiple ways in which nutrition spending can be tracked: through budgetary analysis, public expenditure reviews, National health accounts, the Clinton Health Access Initiative (CHAI) resource mapping tool, the OECD Development Assistance Committee (OECD/DAC) Credit Reporting System (CRS) online database. The report also introduces suggested desirable characteristics of tracking mechanisms, based on standard principles of good practice in public financial management and aid effectiveness (OECD, 2008; World Bank, 1998):

  • Comprehensive: covering all activities of all government and donor levels.
  • Timely: making sure data is up to date and made available regularly.
  • User-friendly: so individuals can easily access and process the data.
  • Aligned and harmonised: to existing systems and processes to facilitate ease of use and information sharing and avoid duplicating work.
  • Owned by those who develop and use the system i.e. all sectors involved in nutrition should have a stake in the system.
  • Incentivised: Individuals and organisations need incentives such as sanctions and rewards to ensure they report financial spending.

The paper then goes on to explore the experiences of four different countries, which have used different methodologies to track nutrition investments at the county level, namely:

  • Tanzania and a Public Expenditure Review;
  • Madagascar and a local resource-mapping tool;
  • Ethiopia and a geographic and actor resource-mapping tool; and
  • Malawi and a simplified public expenditure review.

The paper concludes that the choice of methodology depends on country context, including the sophistication of existing resource tracking systems. Countries showing the most progress on tracking nutrition spending appear to be those that have used methodologies already being used by other sectors, and therefore easier perhaps to install and run. Some of the most difficult decisions surround what to include in the tracking system: which sectors, which expenditures, and from which sources (private or public, government or donor etc). The paper also points out the lack of inclusion of civil society in development of tracking systems despite their knowledge of accountability and calls for greater transparency. Tracking expenditures needs to become part of a larger country-wide system for implementing and monitoring nutrition-sensitive initiatives.

Undernutrition, to be effectively tackled, requires the creation of an enabling political environment. Although enabling environments have been shown to require the same key ingredients (Gillespie et al. 2013; Huang et al. 2015) whatever the development outcome, namely “improving governance and political economy, enhancing capacity and resources, providing evidence, and framing the issues in a compelling way”, their broad scope and reach make it difficult to monitor how they impact nutrition specifically.

Examples of initiatives to monitor enabling political environments for nutrition include:

With a variety of initiatives comes a variety of indicators and although similar in some cases there is a need for much greater harmonisation between monitoring programmes. The World Health Organisation recently released their “Proposed Set of Indicators for the Global Monitoring Framework for Maternal, Infant, and Young Child Nutrition”, which could also combine with these initiatives to create a more comprehensive and universal way of tracking nutrition actions and outcomes.

Tracking both progress towards better nutrition and donor and government spending on nutrition are key for effectively and efficiently tackling malnutrition, and particularly critical as the global community commits to a new set of development goals to address, among many targets, the causes and consequences of undernutrition.

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